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​DDAP Forms 

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The  DDAP-EFM-1002-ASAM Placement Summary Sheet form is being provided by DDAP in the instance there is an entity that is not required to enter the 

ASAM Criteria information into PA WITS, but still wishes to use the form. 

 

  
  
  
Client Liability Determination Form.xls
  
8/2/2018 11:57 AM
Coroners Overdose Reporting Form.pdf
  
9/20/2016 4:16 PM
DDAP-EFM-1002 - ASAM Placement Summary Sheet.docx
  
7/1/2018 4:34 PM
DDAP-EFM-1003 - PCPC Summary Sheet.docx
  
2/26/2016 11:06 AM
DDAP-EFM-1004 - Authorization.docx
  
2/26/2016 11:06 AM
DDAP-EFM-1006 - Services Rendered.docx
  
2/26/2016 11:07 AM
DDAP-EFM-1007 - Client Discharge.docx
  
2/26/2016 11:08 AM
DDAP-EFM-1009 - Grievance and Appeal Reporting.doc
  
2/26/2016 11:16 AM
DDAP-EFM-1600 - Open Beds Registration Form.docx
  
8/26/2016 12:10 PM
Email Registration Request for Facility Directors Form (Fillable).pdf
  
6/21/2018 3:11 PM
Event Request Form 9.2018(1).pdf
  
9/14/2018 9:11 AM
October 2018 Clinical Supervision Training Registration Form.docx
  
9/7/2018 10:10 AM
Ownership and Business Management Form.docx
  
2/16/2017 3:30 PM
Password Security Agreement for Facility Directors Form (Fillable).pdf
  
6/21/2018 3:11 PM
Request for change in facility capacity- Non-NTP.docx
  
6/21/2018 3:12 PM
Request for change in facility capacity-NTP.docx
  
6/21/2018 3:12 PM
Request for Liability Reduction or Elimination Form.pdf
  
8/2/2018 12:08 PM
REQUEST FOR LICENSING APPLICATION PACKET (2).docx
  
6/21/2018 3:12 PM
Request to Flex Beds Form.docx
  
6/21/2018 3:12 PM
Speaker Request Form.docx
  
2/26/2016 11:17 AM
Staffing Requirements Facility Summary Report.xlsx
  
2/16/2017 3:47 PM
Statement of Compliance Form.pdf
  
2/26/2016 11:08 AM